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Severe traumatic brain injury airway before transfer — DIPIMC MCQ

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HardRetrieval and TransportSevere traumatic brain injury airway before transferDIPIMCDipIMC

A 35-year-old motorcyclist has an isolated severe head injury after a high-speed crash on a rural road. His GCS is 7 (E1 V2 M4), he is combative and intermittently vomiting, and the nearest neurosurgical centre is a 40-minute drive away. Oxygen saturations dip to 90% during suctioning. What is the most appropriate management before transfer?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Perform a rapid sequence induction to secure the airway

A GCS of 7 with vomiting and falling saturations indicates an unprotected, at-risk airway that will not tolerate a 40-minute transfer; pre-hospital emergency anaesthesia with a rapid sequence induction and a cuffed tracheal tube secures the airway and allows controlled ventilation to maintain oxygenation and normocapnia, which are central to neuroprotection. A supraglottic airway does not reliably protect against aspiration in a vomiting patient and is a holding measure, while sedation without a definitive airway risks hypoventilation, hypercapnia and aspiration that worsen secondary brain injury. Delaying transfer wastes time in a time-critical injury. Pearl: after securing the airway, target oxygen saturations above 94%, normocapnia and a systolic above 110 mmHg to limit secondary insult.

Reference: NICE NG232 (Head injury); ATACC